Managing bone loss in revision total knee arthroplasty

While the management of bone loss in revision total knee arthroplasty (TKA) has improved over the past decade, it is still challenging for orthopedic surgeons. Small or contained defects may be treated with bone graft, cement augmentation, cement augmentation with screw fixation, or modular augments. It is more difficult to manage large or uncontained defects. Historically, these larger defects were treated with allograft, but within the last decade, tantalum cones and titanium sleeves have been used to obtain better implant fixation where bone deficiency is an issue. These meta-diaphyseal implants can reduce mechanical stress at the level of the joint line, and may reduce the need for fully constrained implants.